title: Higher rates of upgrading and upstaging in older patients undergoing radical prostatectomy and qualifying for active surveillance.
abstract: OBJECTIVE
  To determine pathological and oncological outcomes of patients diagnosed with low-risk prostate cancer in two age cohorts who underwent radical prostatectomy (RP) and qualified for active surveillance (AS) according to Prostate Cancer Research International: Active Surveillance (PRIAS) criteria, as AS for low-risk prostate cancer represents an acceptable management strategy especially for older patients.
  
  
  METHODS
  In all, 320 patients aged ≥65 years who underwent RP and were eligible for AS according to PRIAS criteria were propensity score matched 1:1 to patients aged <65 years. Patient characteristics were compared with chi-square, Kruskal-Wallis, and one-way anova tests. Predictors of RP pathological upgrading or upstaging were analysed using logistic regression. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Predictors of RFS were analysed within Cox regression models.
  
  
  RESULTS
  Pathological upgrading and upstaging were significantly higher among older (≥65 years) vs younger (<65 years) patients (53.1% vs 44.1% and 12.2% vs 7.2%, respectively). Higher prostate-specific antigen levels and increasing age were independent predictors of upgrading among patients aged <65 years. There were no differences in RFS or OS between the two age groups. Positive surgical margin status was the only independent predictor of shorter RFS.
  
  
  CONCLUSIONS
  Patients aged ≥65 years who are eligible for AS by PRIAS criteria have a higher risk of being upgraded and upstaged at RP than those aged <65 years. These findings should be taken into consideration when discussing treatment options for patients diagnosed with prostate cancer.
authors.affiliation: Department of Urology, Charité University Medicine, Berlin, Germany.
authors.forename: Jonas
authors.initials: J
authors.lastname: Busch
authors.forename: Ahmed
authors.initials: A
authors.lastname: Magheli
authors.forename: Natalia
authors.initials: N
authors.lastname: Leva
authors.forename: Michelle
authors.initials: M
authors.lastname: Ferrari
authors.forename: Juergen
authors.initials: J
authors.lastname: Kramer
authors.forename: Christian
authors.initials: C
authors.lastname: Klopf
authors.forename: Carsten
authors.initials: C
authors.lastname: Kempkensteffen
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
authors.forename: James D
authors.initials: JD
authors.lastname: Brooks
authors.forename: Mark L
authors.initials: ML
authors.lastname: Gonzalgo
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011159:Population Surveillance; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate
chemical_list: D017430:Prostate-Specific Antigen
keywords: active surveillance; age; low-risk; pathological oncological outcome; propensity score matching; prostate cancer; prostatectomy